levator spasm, coccygodynia

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  1. levator spasm
    • levator syndrome
    • proctalgia fugax
  2. sx
    • severe episodic, agonizing discomfirt in rectum
    • ddx: hemorrhoid, fissure localized to anal area, this is often on left side
    • wakes patient up from sleep
  3. PE
    • tender spastic PR on left side
    • RP higher than controls in manometry
  4. RX
    • bowel management, toilet training
    • sitz baths
    • levator massage
    • perineal strenthening training exercises
    • biofeedback
  5. RX-chronic
    • muscle relaxants
    • SL, topical NTG and quinine sulfate
    • electrogalvanic stimulation (69% success)-fatigue muscle by overstimulation and contraction
    • steroid caudal block
    • japan linearly polarized near-infrared irradiation
    • refer to pain clinic
  6. coccygodynia
    • spasm of pubococcygeal portion of levator ani
    • pain increases when patient rises from sitting position
  7. coccygodynia-rx
    • bowel managment
    • perineal strengthening exercises
    • levator massage
    • injection of local anesthetic and cortisone-relief temporary
    • coccygectomy
Card Set
levator spasm, coccygodynia
constipation, anal pain
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